HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Operative Techniques in Otolaryngology, Vol 23, No 1, March 2012

References

( Figure 2 ). It goes without saying that multiple, separate tables can be used during a single DISE to record changes in the pattern of collapse that occur after an assessment with jaw thrust or altered body position, for example.

1. Croft CB, Pringle M: Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504- 509, 1991 2. Berry S, Roblin G, Williams A, et al: Validity of sleep nasendoscopy in the investigation of sleep related breathing disorders. Laryngoscope 115:538-540, 2005 3. Steinhart H, Kuhn-Lohmann J, Gewalt K, et al: Upper airway collaps- ibility in habitual snorers and sleep apneics: evaluation with drug- induced sleep endoscopy. Acta Otolaryngol 120:990-994, 2000 4. Rodriguez-Bruno K, Goldberg AN, McCulloch CE, et al: Test–retest reliability of drug-induced sleep endoscopy. Otolaryngol Head Neck Surg 140:646-651, 2009 5. Kezirian EJ, White DP, Malhotra A, et al: Interrater reliability of drug-induced sleep endoscopy. Arch Otolaryngol Head Neck Surg 136:393-397, 2010 6. Marais J: The value of sedation nasendoscopy: a comparison between snor- ing and non-snoring patients. Clin Otolaryngol Allied Sci 23:74-76, 1998 7. Iwanaga K, Hasegawa K, Shibata N, et al: Endoscopic examination of obstructive sleep apnea syndrome patients during drug-induced sleep. Acta Otolaryngol Suppl (550):36-40, 2003 8. Camilleri AE, Ramamurthy L, Jones PH: Sleep nasendoscopy: what benefit to the management of snorers? J Laryngol Otol 109:1163-1165, 1995 9. Hessel NS, Vries N: Increase of the apnoea-hypopnoea index after uvulopalatopharyngoplasty: analysis of failure. Clin Otolaryngol Al- lied Sci 29:682-685, 2004 10. Croft CB, Pringle M: Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16:504-509, 1991 11. Johal A, Battagel JM, Kotecha BT: Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea. Eur J Orthod 27:607-614, 2005 12. Johal A, Hector MP, Battagel JM, et al: Impact of sleep nasendoscopy on the outcome of mandibular advancement splint therapy in subjects with sleep- related breathing disorders. J Otolaryngol Otol 121:668-675, 2007 13. Hessel NS, de Vries N: Diagnostic work-up of socially unacceptable snoring. II. Sleep endoscopy. Eur Arch Otorhinolaryngol 259:158-161, 2002 14. Den Herder C, van Tinteren H, de Vries N: Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115:735-739, 2005 15. Rabelo FA, Braga A, Küpper DS, et al: Propofol-induced sleep: polysomnographic evaluation of patients with obstructive sleep apnea and controls. Otolaryngol Head Neck Surg 142:218-224, 2010 16. Sadaoka T, Kakitsuba N, Fujiwara Y, et al: The value of sleep nasen- doscopy in the evaluation of patients with suspected sleep-related breathing disorders. Clin Otolaryngol Allied Sci 21:485-489, 1996 17. Hillman DR, Walsh JH, Maddison KJ, et al: Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol. Anesthesiology 111:63-71, 2009 18. Pringle MB, Croft CB: A grading system for patients with obstructive sleep apnoea-based on sleep nasendoscopy. Clin Otolaryngol Allied Sci 18:480-484, 1993 19. Abdullah VJ, Wing YK, van Hasselt CA: Video sleep nasendoscopy: the Hong Kong experience. Otolaryngol Clin North Am 36:461-471, 2003 20. Kotecha BT, Hannan SA, Khalil HM, et al: Sleep nasendoscopy: a 10-year retrospective audit study. Eur Arch Otorhinolaryngol 264: 1361-1367, 2007 21. Kezirian EJ, Hohenhorst W, de Vries N, et al: Drug-induced sleep endoscopy: the VOTE classification. Eur Arch Otorhinolaryngol 2011 May 26 [Epub ahead of print] 22. Hohenhorst W, Hortscht M, Grünwald S, et al: Verteilung der Vibra- tions- und Obstruktionslokalisationen unter Propofolschlaf. HNO In- form 29:174, 2004 23. Baisch A, Hein G, Gössler U, et al: [Finding the appropriate therapy with the help of sleep endoscopy]. Laryngorhinootologie 84:833-837, 2005

Complications There are no severe side effects or emergency situations described with DISE in the literature. In more than 7,500 combined endoscopies, endotracheal intubation, tracheos- tomy, or use of flumazenil was never necessary. In case of oversedation, airway management with the use of positive pressure or, in rare cases, a laryngeal mask airway may be required. In cases with marked oxygen desaturation on sleep study, oxygen insufflation (such as 2-4 L/min via blow by face mask or nasal cannula) may help to prevent undesirable desaturations. Saliva aspiration can occur, but it is rare and usually not dangerous. However, it may compromise the procedure, due to extreme coughing. Laryngospasm is rare. Regurgitation and aspiration acid reflux are theoretically possible and might need specific treatment. The authors did not encounter such cases. To prevent complications in high-risk patients such as those with body mass index 35 kg/m 2 , problematic ana- tomical features (short neck, modified Mallampati position IV), DISE may be performed concurrent with positive air- way pressure administration. Conclusions DISE is a valid addition to polysomnography and clinical assessment in an awake patient. Correct technique and per- formance presumed, it is a reliable and safe tool to detect and analyze the phenomena of the upper airway during sleep visually and acoustically. The anatomical structures that are involved in sound gen- eration and obstruction of the upper airway can be identified individually. By identifying specific structures that mediate collapse, surgeons may potentially be able to develop targeted, effective treatment plans. Individual therapeutic planning con- cerning choice and extent of surgical procedures can be opti- mized. With the help of passive maneuvers the potential effi- cacy of intraoral devices or other nonsurgical options can be estimated. Various studies have examined the association be- tween DISE findings and outcomes of palate surgery and mandibular repositioning appliances. We hope introduction of the VOTE system will aid comparison between findings, both intra- and interindividually. The shared use of the VOTE Clas- sification can facilitate the scientific evaluation of DISE in individual centers and, just as importantly, the collection of data across multiple centers. With these data we can compare results across studies and increase our knowledge and find supporting evidence whether DISE is indeed beneficial to the outcomes of existing and novel treatments for snoring and OSA.

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